Rossiter Jennifer, Soor Gursharan, Telner Deanna, Aliarzadeh Babak, Lake Jennifer
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada ; South East Toronto Family Health Team, Toronto, Ontario, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada ; Department of Family Medicine and the Department of Emergency Medicine at Headwaters Health Care Centre, Orangeville, Ontario, Canada.
Int J Family Med. 2013;2013:691454. doi: 10.1155/2013/691454. Epub 2013 Dec 12.
Purpose. Monitoring patients' international normalized ratio (INR) within a family medicine setting can be challenging. Novel methods of doing this effectively and in a timely manner are important for patient care. The purpose of this study was to determine the effectiveness of a pharmacist-led point-of-care (POC) INR clinic. Methods. At a community-based academic Family Health Team in Toronto, Canada, charts of patients with atrial fibrillation managed by a pharmacist with usual care (bloodtesting at lab and pharmacist follow up of INR by phone) from February 2008 to April 2008 were compared with charts of patients attending a weekly POC INR clinic from February 2010 to April 2010. Time in therapeutic range (TTR) was measured for both groups. Results. 119 patient charts were reviewed and 114 had TTR calculated. After excluding patients with planned inconsistent Coumadin use (20), such as initiating Coumadin treatment or stopping for a surgical procedure, the mean TTR increased from 64.41% to 77.09% with the implementation of the POC clinic. This was a statistically significant difference of 12.68% (CI: 1.18, 24.18; P = 0.03). Conclusion. A pharmacist-led POC-INR clinic improves control of anticoagulation therapy in patients receiving warfarin and should be considered for implementation in other family medicine settings.
目的。在家庭医疗环境中监测患者的国际标准化比值（INR）具有挑战性。有效且及时地进行这项工作的新方法对患者护理至关重要。本研究的目的是确定由药剂师主导的即时检验（POC）INR诊所的有效性。方法。在加拿大多伦多一个基于社区的学术性家庭健康团队中，将2008年2月至2008年4月由药剂师按照常规护理（在实验室进行血液检测并通过电话对INR进行药剂师随访）管理的房颤患者病历，与2010年2月至2010年4月参加每周一次POC INR诊所的患者病历进行比较。测量两组的治疗范围内时间（TTR）。结果。审查了119份患者病历，其中114份计算了TTR。在排除计划使用华法林不一致的患者（20例），如开始华法林治疗或因手术而停药后，随着POC诊所的实施，平均TTR从64.41%提高到77.09%。这一差异具有统计学意义，为12.68%（CI：1.18，24.18；P = 0.03）。结论。由药剂师主导的POC - INR诊所可改善接受华法林治疗患者的抗凝治疗控制，应考虑在其他家庭医疗环境中实施。
